Antithrombotic Regimens in Patients Undergoing Transcatheter Aortic Valve Implantation

Tabata, Noriaki; Tsujita, Kenichi

doi:10.1253/circj.cj-17-0052

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References 16 publications

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“…Although the rate of periprocedural bleeding events may be relatively lower in TAVI compared to that in surgical aortic valve replacement (11.3%, 22.7%, respectively) [4], it itself remains absolutely high at present (10.6–14.0%) [1]. In addition, the current guidelines recommend dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel, for a 3- to 6-month period after TAVI, though it is not evidence-based [5]. In fact, two recent reports concluded that aspirin monotherapy alone tended to reduce the risk of bleeding without increasing the rates of total death, acute coronary syndrome (ACS), and stroke in AS patients who underwent TAVI [6,7].…”

Section: Introductionmentioning

confidence: 99%

Reduction in thrombogenic activity and thrombocytopenia after transcatheter aortic valve implantation — The ATTRACTIVE-TTAS study

Ishii

Kaikita

Mitsuse

et al. 2019

IJC Heart & Vasculature

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Introduction Bleeding complications after transcatheter aortic valve implantation (TAVI) is a major problem in clinical practice. However, there is few information on thrombogenicity after TAVI. The aim of this study was to establish a monitoring of total thrombogenicity in perioperative TAVI using the Total Thrombus-formation Analysis System (T-TAS), a microchip-based flow chamber system for analysis of thrombus formation under flow condition. Methods Twenty-three patients with severe aortic stenosis who underwent TAVI between August 2017 and March 2018 at Kumamoto university hospital were enrolled. After exclusion, data of 21 patients were analyzed. Blood samples were obtained before, 2, 7, and 30 days after TAVI. Thrombogenicity were assessed by the T-TAS to compute the area under the curve (AUC) (AR 10 -AUC 30 ) in the AR chip. We also measured platelet count, high-molecular-weight von Willebrand factor (HMW-vWF) multimers, and plasma thrombopoietin. Computational fluid dynamics (CFD) analysis was performed to calculate the wall shear stress (WSS). Results The AR 10 -AUC 30 levels and platelet counts were significantly lower at 2 days post-TAVI, and then increased gradually. HMW-vWF multimers, and plasma thrombopoietin, were significantly higher at 2 days post-TAVI, compared with before TAVI. CFD analysis showed that WSS of the aortic valve and posterior ascending aortic wall were significantly lower after TAVI than before-TAVI. Multivariate analysis identified max velocity measured by echocardiography, platelet count, and D-dimer as significant determinants of AR 10 -AUC 30 , representing total thrombogenicity. Conclusions Although HMW-vWF multimers improved earlier after TAVI, total thrombogenic activity evaluated by T-TAS remained relatively low followed by improvement in thrombogenic activity at 30 days after TAVI. Clinical Trial Registration: https://clinicaltrials.gov . Unique identifiers: NCT03248232 .

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